Traumatic brain injury

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Assessment of the patient who has suffered a concussion must be first carried out by a specialized physician the kind of multimodal assessment that can lead to successful interventions may be done by other professionals. Hospital assessments detect certain types of damage, commonly sub-dural haematomas, or less common intraparenchymal haemorrhage but are unlikely to detect the cause of symptoms that the patient is experiencing. MRI and CAT scans often show no abnormality. In addition, traditional rehabilitation often meets the criteria of conservative do no harm but may do little to remedy the deficiencies caused by minimal to moderate injury.

The methodology for efficient and accurate assessment that can lead to effective intervention includes quantitative electroencephalogram (QEEG). These can reveal the effects of damage elicited by stretching and twisting of axons, called diffuse axonal injury (DAI). Traumatic brain injury (TBI) will often have a negative impact on the right and/or left insula in the cortex of the brain that, in turn, relates to changes in heart rate variability (HRV). Thus concussion assessment should measure QEEG, HRV, and, using continuous performance tests (CPT), measure attention, impulsivity and variability of response time. This should be combined with neuropsychological testing, in particular for short and long term memory, attention span, impulsivity and questionnaires regarding medical health, depression, and anxiety.

Most importantly, interventions that are based on these assessments have been highly successful with multimodal EEG Biofeedback therapy.